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Organization
SIUMAN FAN DDS INC.
Active
Organization
SIUMAN FAN DDS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIUMAN FAN DDS (PRESIDENT)
(619) 692-4310
Entity
Organization
Contact information
Practice address
2020 CAMINO DEL RIO N, 101, SAN DIEGO, CA 92108-1541
(619) 692-4310
Mailing address
2020 CAMINO DEL RIO N, 101, SAN DIEGO, CA 92108-1541
(619) 692-4310
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
36241
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811070295
TYPE 1 NPI
—
Enumeration date
10/06/2007
Last updated
10/06/2007
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